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Therapeutic Reflections: Dealing with Suffering Compassionately

On Kindness, compassion fatigue and what to do about it. #compassion #compassionfatigue #psychotherapy #suffering #psychology

Photo by Caroline Hernandez on Unsplash

Introduction

Contemplative practices have always been a part of my life. Though regular meditation and going to retreats was a common thing as a child, raised in a Buddhist household, I wasn’t particularly mindful nor religious. Yet something that has come easier to me is practicing kindness. Being kind and compassionate is a part of our neurobiology as social beings (see Siegel & Drulis, 2023, on interpersonal neurobiology and Shore, 2021, on mutual love and play)⁰. Being caring is part of our nature.

Kindness is not a sign of weakness

When people think of loving kindness/active empathy (aka compassion¹) people think it has a soft, “fluffy” and weak connotation. Yet this is not necessarily so. Dr. Kristin Neff mentions the concept of fierce compassion². Think of a parent caring for their child: they are willing to be gentle but if necessary protect their young at all costs. Moreover, being compassionate to a child, also means teaching values and setting boundaries where necessary, to enable to best flourishing of the child. Dr. Neff, speaks about finding the right balance between gentleness and fierceness. It is about a healthy integration of seemingly opposite forces. Being kind and compassionate means acting in an empathic manner - but it also means being compassionate of oneself and hence willing to set boundaries if people do not care or overstep our boundaries. True compassion inherently fosters inner strength, independence and interdependence.³ A more thorough definition of compassion is that it involves:

a) an awareness of suffering (cognitive component)

b) a caring and tender concern (affective component)

c) a genuine wish to see the relief of that suffering (intentional component)

d) a readiness to take action (motivational component) (Goldin & Jazaieri, 2017)⁴

Yet reality means that humans that work in health care or as first responders are faced with vast amounts of suffering, and it is not always clear how they manage this. Think about all the nurses, police offers, doctors, therapists, social workers, etc. who see an incredible amount of human suffering and try to alleviate this by offering care. Next to systemic challenges (the institutions we work for and how they’re managed; socio-political difficulties; economic struggles), care workers are at a high risk of suffering burn-out or compassion fatigue.

Compassion Fatigue

Compassion fatigue is a phenomenon where care workers become emotionally exhausted and overwhelmed by the suffering of their clients, leading to a reduced ability to feel empathy or compassion. It can result in physical, emotional, and mental exhaustion, as well as a decrease in job satisfaction and quality of care provided. It is a common experience for those working in high-stress professions, such as healthcare, counseling, and social work. I've experienced being less patient and understanding with my family, after a challenging workday. Compassion fatigue (or more acurately empathy fatigue) is a serious issue that can negatively impact not only the care worker, but also the quality of care they provide (though they can still deliver professional work). It is important for organizations to recognize the risk of compassion fatigue and take steps to support their workers.

How therapists are trained to deal with suffering

Working as a psychotherapist/psychologist for young people and adults developed quite naturally, albeit with a lot of effort and training. What is interesting is that even in my postgraduate training not much attention was paid on how to deal with the suffering we witness as therapists. It is implied that we engage empathically and professionally with our clients; that we are present yet not so emotionally involved as to suffer ourselves or lose focus and clarity of judgement. I was told to focus on Carl Rogers’ concept of empathy where we train our “ability to understand another person's experience in the world, as if you were that person, without ever losing the “as if” sense”⁵.

Though theoretically useful, it wasn’t always an antidote to the overwhelming intensity of the work. Moreover, standard practices recommend:

a) getting your own supervision (having a more experienced therapist supervise your work);

b) intervision (meeting with colleagues regularly to discuss your work with clients anonymously); and

c) following your own therapy if necessary.

Compassion as antidote

In addition to traditional self-care practices such as supervision and therapy, some therapists and care workers have found that the practice of self-compassion and tonglen can be useful in combating compassion fatigue. Self-compassion involves treating oneself with kindness and understanding, similar to how one might treat a good friend. It means offering the same diligence and quality of care for oneself as we do for our clients. Tonglen is a Tibetan Buddhist practice that involves taking in the suffering of others and sending out love and compassion in return. These practices can help care workers cultivate empathy and compassion for themselves and others, which can in turn lead to greater resilience and job satisfaction. As confusing as it sounds cultivating compassion can help with compassion fatigue. In a way compassion fatigue might more acurately be descriped as empathy fatigue. It means that one empathizes but feels overwhelmed, powerless and often times does not pay enough attention to one’s own needs (self-compassion). True compassion focuses on the self and other, and wants both to flourish as much as possible, fostering each person’s independence and interdependence.

Some additional ways to deal with compassion fatigue:


  • Mindfulness Meditation: Practicing mindfulness meditation can help care workers stay present and engaged with their clients while also reducing stress and increasing well-being. Mindfulness meditation involves focusing on the present moment with curiosity and acceptance, without judgment or distraction. This can help care workers cultivate a sense of inner calm and resilience, which can be valuable in the face of the emotional demands of their work.

  • Physical Exercise: Exercise can help reduce stress and improve mood, which can help care workers better cope with the emotional demands of their work. Engaging in regular physical activity can help care workers feel more energized and focused, and can also provide an opportunity for social support and connection.

  • Creative Expression: Engaging in creative activities, such as art or music, can help care workers process their emotions and find meaning in their work. Creative expression can provide an outlet for emotions that may be difficult to express in words, and can also help care workers connect with their own sense of purpose and passion.

  • Boundaries: Setting clear boundaries with clients and taking breaks when needed can help prevent burnout and compassion fatigue. Healthcare providers may find it helpful to establish limits around their work hours, communication with clients outside of appointments, and the amount of emotional energy they invest in each client. Taking regular breaks and vacations can also help care workers recharge and prevent burnout.


These are just a few basic suggestions on how to deal with suffering and compassion fatigue, yet it is a personal journey to figure out what works best. Additionally, seeking support from colleagues, supervisors, or mental health professionals can be an important part of dealing with compassion fatigue.

A few years ago I followed a course in Compassion Cultivation Training, created by Dr. Thupten Jinpa, former monk and translator of the Dalai Lama, in collaboration with Stanford University. It had a deep impact on my life. Around that time I was working in a multidisciplinary clinic seeing 7-8 clients a day. Often one can only do so much, and being more able to be kinder with myself, my own shortcomings, but also genuinely wishing my clients and people in general well, was very powerful. When being overwhelmed with the seemingly unsurmountable pain of others, the common phrase I had in my mind was: “Just like me, other beings are suffering. May you be free of unnecessary suffering, filled with joy and inner peace”. The simple act of wishing the other person well, brought some equanimity and made me also more present to the moment. Sometimes just being present can very helpful in itself. And sometimes from there, practical solutions can also arise. My next step in this kindness journey will be to follow the Compassion Cultivation Teacher Training in the coming 1.5 years. After a rigorous 9 month training I will hopefully be able to teach compassion cultivation course for free under supervision, after which I’ll be fully certified.

Conclusion

As care workers, it is important to remember that we are human and that it is natural to be affected by the suffering of others. By cultivating (fierce) compassion for ourselves and our clients, we can better care for those in need while also protecting our own well-being. We don’t have to be self-less hero’s and burnout, yet not caring is also no option to do our work well and joyfully. Maybe a good way to start is by asking ourselves:

"Did I offer peace today? Did I bring a smile to someone's face?Did I say words of healing? Did I let go of my anger and resentment? Did I forgive? Did I love? These are the real questions. I must trust that the little bit of love that I sow now will bear many fruits, here in this world and the life to come." - Henri Nouwen

References

⁰ Siegel, D. J., & Drulis, C. (2023). An interpersonal neurobiology perspective on the mind and Mental Health: Personal, public, and planetary well-being. Annals of General Psychiatry, 22(1). https://doi.org/10.1186/s12991-023-00434-5

⁰Schore, A. N. (2021). The interpersonal neurobiology of Intersubjectivity. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.648616 ¹ Goetz, J. L., Keltner, D., & Simon-Thomas, E. (2010). Compassion: an evolutionary analysis and empirical review. Psychological bulletin, 136(3), 351–374. https://doi.org/10.1037/a0018807

² Kristin Neff on Fierce Self Compassion: https://youtu.be/JVgb9yXeVCY ³ Stephen Covey: "Dependent people need others to get what they want. Independent people can get what they want through their own effort. Interdependent people combine their own efforts with the efforts of others to achieve their greatest success."

⁴ Goldin, P. R., & Jazaieri, H. (2017). The compassion cultivation training (CCT) program. Oxford Handbooks Online. https://doi.org/10.1093/oxfordhb/9780190464684.013.18; see The compassion cultivation training (CCT) program for full chapter.

⁵ Neukrug, E. (2017). Creative And Novel Approaches to Empathy. Counseling Today, Retrieved via: https://ct.counseling.org/2017/02/creative-novel-approaches-empathy/

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